Basic Information
| Provider Information | |||||||||
| NPI: | 1669475117 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINA EYE SURGICAL AND LASER CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1002 N CHURCH ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368544441 | ||||||||
| FaxNumber: | 3368547883 | ||||||||
| Practice Location | |||||||||
| Address1: | 1002 N CHURCH ST | ||||||||
| Address2: | STE 200 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368544441 | ||||||||
| FaxNumber: | 3368547883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2005 | ||||||||
| LastUpdateDate: | 06/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | BERGIN | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | JOHN | ||||||||
| AuthorizedOfficialTitleorPosition: | OPHTHALMOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 3368544441 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 23173 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.